Giving birth - and advocating for myself
As per my last blog, it’s almost midnight and I’ve just fallen asleep when I feel water gushing out. Waters breaking. I’m almost 38+6. She’s arriving sooner than we expected!!
I call my parents first (before I call downstairs to my husband #priorities) and tell them to jump in the car – luckily they’re only a 20 minute drive away. We head straight to the hospital to get checked out and see how dilated I am. Having your waters break doesn’t mean labour is imminent – this happened with my first and he didn’t arrive for another 40 hours. But they do induce fairly soon (within 36 hours or so) after as there’s a risk of infection after waters break.
With COVID hubby has to sit in the freezing car outside while I have checks. I’m not so much dilated but I’m having contractions and they are getting closer. I’m timing them with an app and using my TENS machine to manage the discomfort. (TENS machines use electrical impulses to block pain signals. I highly recommend them – would not have survived early labour without them each time! They are about £30 so worth the investment).
So I end up lying on a ward for a few hours seeing if they get stronger. I’m nervous about going home – I send John home so he can have a bit of sleep but end up calling him back an hour later. The contractions got to 3 minutes apart but then went out to 7. If I'm not going to be actively pushing a baby out I want to be home for when the boys got up!
We’re home at 7am with an induction booked for the following morning at 8am in case nothing happens. My mum is already cleaning my kitchen and organising my house. I should call them over more often.
I have a Women in Sport strategy session (I'm a Trustee) scheduled in parts during the day. I’m still having contractions though they’re fairly mild so I join at 9am – warning everyone I’ve been in hospital all night and am a bit tired (I don't tell them I'm in labour). At 10.30 I’m trying to give my view on something and can barely talk as the contractions are getting stronger (am guessing the board has all worked it out by now!). They’re now 90 seconds-2 minutes apart so we jump in the car!
We call ahead and the amazing midwives are already filling the birthing pool when we arrive. I’m straight into the delivery room and start maxing out the TENS machine every contraction. I’m literally singing my way through transition. Very loudly. It’s bloody painful after all. But I know it won’t last long.
I happened to find all the notes on my last labour whilst unpacking our final moving boxes last week. I hadn’t thought about it much since – it’s not something I particularly wanted to re-live – but it was so helpful to read what happened (there were a few tears shed).
I’d forgotten about the stages. I’d forgotten how I handled it. And I’d forgotten the incredibly upsetting period after she arrived where I didn’t have skin to skin for half an hour whilst I was used as a training tool for stitches for a trainee midwife. Where Cormac was taken out of sight with no word as to whether he was ok. I briefed hubby that under no circumstances was this to happen again. I likely won’t be able to think straight and advocate for myself in labour. So he needs to step in for me. As an aside - that is a huge job of the birthing partner. It's not just all giving us snacks and massages. Though they are good too.
Back to labour and the pool can’t be filled quickly enough. We have a lovely trainee midwife helping us – we find out later this is only her third delivery and first in a pool so she wants a second check on the water temperature while I’m desperate to get in! The TENS machine is amazing at helping with the pain but it really is maxed out now and I know how warm water is so much better. On that note I recommend having a few of those sports gel packs in the house for labour – having them heated up on your back can take a lot of the pain away (labour pains are strangely mostly in your back).
So I get in the pool and everything slows down. The warm water has such a calming effect. The midwives ask if I want to get out to get things moving but I’m enjoying the break! As long as she's safe (and they're checking her HR every 15 mins) I'm happy. Mentally I need to prepare myself.
But I have contraction after contraction - it feels like its taking too much time and I get more and more frustrated they can’t feel her head yet! Eventually (about an hour later) I’m starting to feel the need to push. Her head is coming out and I feel I can’t breathe – I’m trying to keep the push going so she comes out this contraction. Finally it does and one contraction later her body follows which I can only describe as the biggest feeling of relief ever!
She’s caught by the trainee who is visibly excited by her first water catch and straight away she’s with me for skin to skin. I opt for the injection to get the placenta out quicker – it needs a bit of a tug and hubby definitely looks a bit queasy from all the blood but no issues there.
The good news is I don’t need stitches which I have done my past pregnancies. It’s my third pregnancy, so I’m all stretched out down there already, and her head is a lot smaller than Cormac’s was so they were less likely. But I do think having the aniball helped somewhat.
It’s a strange feeling at this time. On one side I’m overcome with love for this little baby and wanting to nuture her, feed her, cuddle her. On the other I’m actively managing the situation – and wanting to know how quickly we can get out of there! I feel a strong urge to get back to my boys and pull our new family together.
(I force my hubby to cut the cord this time. He's chickened out with the first two babies but I decide he has to do this one)
After labour there seem to be a stack of decisions needing to be made. From the placenta injection (or not), to whether baby has vitamin K, to feeding and more. During pregnancy, these were all raised by my midwife, I was given lots of information, could ask questions and think about what to do. The answers are now automatic – I don’t have to think. After you have given birth is not the right time to consider important decisions.
So I’m really surprised when around an hour after I give birth I’m told I’ve been risk assessed for blood clots and need to have a course of Heparin injections (blood thinners) over the next 10 days. It’s the first I’ve heard of it during pregnancy and immediately I ask why I haven’t been told before, and why I should need them this pregnancy when I haven’t had them the others. The answer from the midwife is that I score 2 out of 3 on risk factors which means “I need them”. The 2 factors being that I’m over 35 and this is a 2nd or more pregnancy. Nothing else.
I ask why women get the clots and if there’s anything I can do without medication to avoid this. Apparently it’s because postnatal women don’t move enough after birth….. I ask them if they’ve checked my file about my activity levels. I’m fully intending on doing the school run tomorrow which is a hike up a hill and back.
I have to speak to a doctor to refuse them who instead of reviewing my situation, tries to convince me to have them. It’s just policy I’m told. I argue a proper assessment of ME, not my arbitrary stats would say I didn’t need them. I’ve been given no details of any side-effects or risks in having them. So I ask what the warning signs would be of clots and say I’ll monitor myself. I understand how dangerous they are and will be highly vigilant. They are still not happy.
There are a few things wrong with this. Firstly, treating mothers as falling into crude buckets rather than treating the individual. If you’ve read my pregnancy training blog, you’ll know this is a subject that infuriates me! Whilst I’m confident enough to challenge decisions, most mums aren’t. But very woman is different, every pregnancy is different. Very little guidance truly applies across the board (not smoking and not taking drugs is probably it!). Just as there is so little research on exercise in pregnancy (which thankfully is now changing), the typical advice is to be cautious, despite the very real benefits.
Secondly, not forewarning us before we give birth so we can do the necessary research, as we can do with the vitamin K injection for our babies, or the injection to deliver the placenta quicker. We are so vulnerable after we give birth it is not the right time to deliver new news. And then not supporting the mother’s right to choose for ourselves. My choice was clearly inconvenient to the doctor as it might have needed some paperwork!
As an aside here’s a beautiful article written by Dr Dawn P Richards about why we need to treat the person and not the patient https://bjsm.bmj.com/content/54/23/1376
The patient as person: an update
British Journal of Sports Medicine 2020;54:1376.
I feel somewhat vindicated at my follow-up appointment when my midwife herself gets angry they tried to force them on me…
Anyhows back to post labour and the insane after pains. No-one tells you about these – essentially the uterus contracting back to its normal size over a few days. They get worse every pregnancy as it gets “better” at its job. And they mostly come on when you breastfeed – our bodies are rather smart with breastfeeding sending signals that the baby is out. I try to convince the doctor to give me some decent pain killers but after my performance with the blood thinners they only give me a few paracetomol!
A couple of hours after Saoirse is born (it's an Irish name pronounced ser-sha - hubby is from Cork - and it means freedom) John and I are already working out how to escape. The midwives assume I’m staying the night but I want to be back before the boys’ bedtime. She’s looking very healthy, is feeding well and in a world of COVID I just think we’ll be safer at home. Reluctantly they let us out (we have to go back tomorrow for a new baby check) and we’re home less than 4 hours after she popped out.
As all pregnancies are different, so are all labours. My first was 40 hours, with a 3 day stay in hospital after. My “goal” to have a water birth was thwarted when he got stuck and they took me out of the pool for an episiotomy then ventouse (making a cut down there then sucking him out). After then I realised that my only goal for future pregnancies was to get my baby out safely – whatever that entailed. So each time after I planned for all occurrences - having extra clothes in my bag in case I needed a caesarean and a longer stay in hospital for example.
This is just one labour story – I’d encourage you to read many more so nothing that happens can be a surprise. So you have mentally prepared for anything that can happen – and know it might not follow your plan – no matter how many pages you have written! "Emergency C-section" is a very common outcome. Sometimes that's just what it takes to get your baby out safely and keep you safe too. And so both mothers and their partners should be aware of this and prepared for it.
It's also important that you prepare for what comes next! I wrote in my last post about how I prepared for afterwards – logistics wise – but body wise is equally important. The issue was that I scheduled my physio call to plan this for when I was 39 weeks pregnant and well…. She’d already arrived! So the morning after I give birth I end up chatting to Emma on zoom not so much on how I’m going to prepare for labour but what I need to do now!!
This is part of my film so I won't spoil the surprise and screenshot her face when she sees a baby instead of a bump (obviously I didn't tell her before ...). Weeks 0-6 diary to follow!